CPE Provider Registration Form
All persons or organizations seeking to provide Continuing Professional Education (CPE) activities to
educators for certificate renewal purposes must register with the Texas Education Agency.
The following entities are pre-approved as providers of continuing professional education and
are required to fill out Sections A and B of the subsequent form.
Texas public school districts;
Regional education service centers;
Accredited institutions of higher education;
Professional education membership associations that have offered professional development
in Texas for at least five years and have tax exempt status, or a state association affiliated with
a national association with tax exempt status;
Accredited non-public Texas schools;
Texas Education Agency; and
State Board for Educator Certification.
All other entities and organizations are not pre-approved and are required to fill out Sections
A, B, and C of the subsequent form.
When complete, go to “File” in the menu. Select “Attach to email.” send to Sandra Nix at
Or you may FAX the form to (512) 936-8231.
All questions regarding the CPE provider registration process should be directed to the Division of
Educator Standards staff at (512) 936-0742.
NOTE: CPE Professional Development credit hours do not include credit toward
Gifted/Talented training or Board Member and Officer training requirements.
For information regarding the required Gifted/Talented (G/T) 30-hour training and 6-hour
updates, contact the Division of Curriculum: (512) 463-9581 or email@example.com.
MSG/TG/BA 2-03-2009 (Rev)
TEA Division of Educator Standards
TEXAS EDUCATION AGENCY
CPE Provider Registration Form
General Instructions: All Pre-Approved providers of Continuing Professional Education (CPE)
activities for standard certificate renewal must complete Sections A and B. All Prospective Providers
must complete Sections A, B, and C.
Part 1 – Provider Information
Name of Provider (Individual or Organization)
Street Address or P.O. Box City State Zip
(Area) Phone Number Extension (Area) Fax Number
Primary Contact Person Contact Person Title
E-mail Address Website Address
County Name (required) County-District Number (if applicable)
Tax Exempt ID Number [if applicable under 26 USC §501(C)(3)-(C)(6)]
Part 2 – Intended Geographic Area, CPE Audience, and Grade Level
Check all that apply in each category below:
Geographic Area(s) CPE Audience (all applicable) Grade Level(s)
Local Teachers Elementary (PK-5)
Regional Administrators Middle School (6-8)
Statewide Certified Support Staff High School (9-12)
ESC #_____ Paraprofessionals
STATE BOARD FOR EDUCATOR CERTIFICATION USE ONLY
Date Received Date Approved Provider ID Number
Part 3 – Content Development CPE Areas (check all that apply)
English Language Arts Fine Arts
Speech Communication Theatre
Languages Other Than English Gifted/Talented Strategies (not counted toward
(i.e. Spanish, French, German) required 30-hr G/T Training or 6-hr G/T Annual Prof Dev)
Spanish/Language Arts (EC-4) Hearing Impaired
Bilingual Education Mild/Moderate SPED
ESL Profound/Severe SPED
Math Visually Impaired
Science SPED Other
Earth Science Technology Applications
Life Science Career and Technology Education
Physical Science Agricultural Science
Social Studies Business and/or Marketing Education
Economics Career Connections/Career Investigation
Geography Family and Consumer Sciences
Government Health Science Technology Education
History Technology Education
Psychology Trade and Industrial Education
Sociology Other Content Areas (specify):
Part 4 – Professional Development CPE Areas (check all that apply)
District/Campus Priorities Professional Standards: Teachers
Instructional Strategies Professional Standards: Master Teachers
Child Development and Research Professional Standards: Principals
Discipline Management Professional Standards: Superintendents
Applicable Federal and State Laws Professional Standards: School Librarians
Diversity and Special Needs Populations Professional Standards: School Counselors
Increasing/ Maintaining Parental Involvement Professional Standards: Ed Diagnosticians
Integrating Technology into Ed. Practices Youth Violence
Ensure Students Read On/Above Level School Crisis Management
Obstacles to Student Learning Other/Emerging Prof. Dev. Issues/Topics:
Other Related Prof. Dev. Issues/Topics:
SECTION B – Provider Assurances
All providers must meet the following requirements:
1. The provider must supply documentation of clock hours of continuing education to the educator.
Such documentation must include the provider’s county/district number or the registration
identification number assigned by TEA.
2. The provider must specify to the educator what the content and numbers of approved Continuing
Professional Education (CPE) clock hours are for each CPE activity.
3. The provider must comply fully with the nondiscrimination provisions of all federal and state
statutes, laws, and rules and prohibit unlawful discrimination in the provision of CPE activities to
any certified educator.
4. Sessions offered by the provider must contribute to the advancement of professional knowledge
and skills identified by the standards and proficiencies of the State Board for Educator
5. The provider must conduct an ongoing in-depth self-study to systematically assess the CPE needs
and priorities of educators served by the provider as well as the quality of the CPE activities
6. The CPE activities offered must promote high levels of student learning for all students and
provide educators access to various models of effective practice such as training, individually-
guided, inquiry, observation/assessment, and development/improvement processes.
7. The provider will make Texas Education Agency contact information available to educators at all
sessions in order to facilitate requests for TEA application forms, additional information, or
8. Providers who contract with other individuals or entities for the delivery of CPE activities must
monitor the quality of those activities.
9. The provider must maintain, update, and make available to educators a listing of all CPE activities
offered for certificate renewal. Providers are encouraged to post CPE activities on the web.
10. The provider is required to maintain a list of CPE activities provided that includes a list of
attendees, the date and content of the activity, and the number of clock hours that count toward
satisfying CPE requirements.
NOTE: The individual signing below must have the authority to provide the assurances above on behalf of the
provider. By signing below, the individual is representing that he or she has such authority. This individual may
be, but is not required to be, the primary contact person listed in Section A, Part 1 above.
On behalf of the provider designated on this form, I understand and agree to the above requirements
and verify that the information provided on this form is true, correct, and complete.
Printed Name of Individual Provider or Authorized Representative
Title of Individual Provider or Authorized Representative
Signature of Applicant or Authorized Representative Date
General Instructions: Please provide clear written responses to the following items.
(Note: Applicants may also be asked to supply additional information upon request.)
1. Submit short vitas or résumés of your main program design team members, lecturers, or
presenters. Each vita or résumé should be no longer than two pages, and must include
college degrees, certifications, and years of experience offering professional development
activities. In addition, briefly describe your organization’s qualifications and experience to
provide professional development activities to educators.
2. Describe your typical professional development activity or workshop for educators. What is
the title (if any)? What is the typical length? What are the learning objectives? What
method(s) of delivery and materials are used? What will participants gain from your activity?
Complete the chart below:
Necessary Information Describe Your Activity or Workshop
Title of Activity or Workshop
Method(s) of Delivery
What do participants gain?
If you provide more than one professional development activity or workshop, describe at least one
more in a similar chart as the one above. List the other most frequently offered ones below. Use
the same workshops/activities on the chart(s) above as the basis for responses to questions 3-6.
List of Other Workshop/Activity Offerings:
3. How do you evaluate the effectiveness of your professional development activities or
workshops? Attach a blank evaluation document.
4. Describe how your activities/workshops meet the Texas criteria for quality professional
development. All six indicators may not apply in some cases, therefore discuss as many as
applicable. (See http://www.sbec.state.tx.us/SBECOnline/certinfo/pdichrt.pdf for additional
Complete the chart below:
Professional Development Indicators How your activity/workshop contributes
5. Describe how your activities or workshops meet the Texas Proficiencies for teachers, which
are found in Texas Administrative Code (TAC) §150.1002. All eight domains will not apply in
most cases; therefore address only those that do apply to your activity/workshop. (For more
information, see http://info.sos.state.tx.us/pls/pub/readtac$ext.viewtac.)
Complete the chart below:
Domain # (s) and Title(s) How your activity/workshop contributes
Domain I: Active, successful student
participation in the learning process;
Domain II: Learner-centered instruction;
Domain III: Evaluation and feedback on
Domain IV: Management of student
discipline, instructional strategies, time
Domain V: Professional communication
Domain VI: Professional development;
Domain VII: Compliance with policies,
operating procedures and requirements;
Domain VIII: Improvement of academic
performance of all students on the
campus (based on indicators (included in
the Academic Excellence Indicator
6. For activities or workshops in academic content areas only (Section A, Part 3), list relevant
Texas Essential Knowledge and Skills (TEKS) by number for specific grade level, and explain
how your activities contribute to enhanced educator understanding. Refer to activities
mentioned in Question 2. The TEKS can be found at
Complete the chart below using the example as a guide:
TEKS Activity/workshop contribution
to educator understanding
Example: Math, Grade 4
(4.1) Number, operation, and quantitative
reasoning. The student uses place value to
represent whole numbers and decimals.